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Annals of Plastic Surgery

Georgi IIliev, Polina Petrova Ivanova, Plamen Nedev, Hristo Popov
Gout is a disease characterized by abnormal metabolism of the uric acid, leading to undesired buildup of monosodium urate crystals affecting mainly the first metatarsal-phalangeal joint of the foot and less commonly other joints or the soft tissues of the body. The prevalence of the disease increases with age, and it is statistically more observed in men than in women.We present the case of a 62-year-old male patient diagnosed as having gout 20 years ago. He came to the clinic with a nasal hump and a mass growing in his nose for the last 3 years, presenting as a nasal obstruction and facial deformity...
February 5, 2019: Annals of Plastic Surgery
Jeremy A Goss, Reid A Maclellan, Arin K Greene
BACKGROUND: Lymphoscintigraphy is used to confirm the diagnosis of lymphedema. One end point for the test is to ensure a patent thoracic duct by uptake of tracer in the organs. The purpose of this study was to evaluate transit of radiolabeled colloid to the organs to gain insight into the etiopathophysiology of primary lymphedema. METHODS: Patients treated in our Lymphedema Program between 2009 and 2018 were reviewed. Only subjects with bilateral lower extremity primary lymphedema were included (individuals with unilateral leg lymphedema were excluded because the tracer will reach the venous circulation and organs through the normal extremity)...
February 5, 2019: Annals of Plastic Surgery
Nicholas C Oleck, Andrew A Dobitsch, Farrah C Liu, Jordan N Halsey, Thuy-My T Le, Ian C Hoppe, Edward S Lee, Mark S Granick
PURPOSE: Falls are a leading cause of nonfatal injury in the pediatric population, resulting in numerous hospitalizations. Children may not have fully developed reflexive and balancing abilities, rendering them more susceptible to traumatic falls. Here the authors present their findings regarding patterns of facial fracture and concomitant injury seen in the pediatric population secondary to falls. METHODS: A retrospective chart review was performed of all facial fractures as a result of falls in the pediatric population in a level 1 trauma center in an urban environment (University Hospital in Newark, NJ)...
February 5, 2019: Annals of Plastic Surgery
Anna Rose Johnson, Miguel G Bravo, Melisa D Granoff, Bernard T Lee
BACKGROUND: Hispanics are the second largest demographic that underwent cosmetic surgery in 2017. The popularity of cosmetic surgeries among this group has increased significantly within the past decade and is projected to continue rising. Patient-directed websites that provide educational materials addressing these procedures should include information that is accurate, comprehensible, and sensitive to the demographic's diverse cultural and ethnic needs. Online health resources have been shown to vary significantly in their quality and reliability...
February 5, 2019: Annals of Plastic Surgery
Marisa Manzano Surroca, Francisco Parri, Xavier Tarrado
INTRODUCTION AND OBJECTIVES: The literature reports many variations of Poland syndrome, which is a congenital disorder and a rare condition. The associated features are extremely variable, including alterations in the ipsilateral thorax and upper extremity and other malformations. This is used to designate the condition as Poland sequence (PS) because a sequence is a primary defect with a secondary cascade of structural changes. It is generally accepted that it is characterized as pathognomonic by absence/aplasia of the sternocostal aspect of the pectoralis major muscle of one side...
February 1, 2019: Annals of Plastic Surgery
Patrick R Keller, Steven Schneeberger, Brian C Drolet, Salam Al Kassis, F Bennett Pearce, Galen Perdikis
INTRODUCTION: Facial trauma is common and carries significant morbidity and cost. Suboptimal interdisciplinary communication is associated with negative health outcomes. This study evaluates the clinical impact of implementation of American College of Surgeons Trauma Quality Improvement Program (TQIP) interdisciplinary communication guidelines between facial surgery and trauma teams. METHODS: Patients with facial trauma presenting to our level 1 trauma center between May and December 2017 were included (N = 812) and split into 3 groups, each anonymously representing a service that treats facial trauma...
January 28, 2019: Annals of Plastic Surgery
Sukru Yazar, Altug Altinkaya, Fuat Baris Bengur, Emine Cigdem Karadag, Halil Kara, Cihan Uras
BACKGROUND: Immediate breast reconstruction in 1 stage using permanent implants is gaining popularity and can be performed with or without the use of acellular dermal matrices. This study aimed to investigate the results of breast implants placed submuscularly without acellular dermal matrix and assess the factors affecting surgical complications. METHODS: From November 2009 to March 2018, 138 patients underwent immediate breast reconstruction with permanent submuscular implants after concomitant skin-sparing or nipple-sparing mastectomies in a single institution...
January 28, 2019: Annals of Plastic Surgery
Christopher Homsy, John T Lindsey
BACKGROUND: With the introduction of latest generation ultrasound technology and its easy availability and portability, regional anesthetic blocks, which were formally in the domain of anesthesiologists, have now become available to practicing plastic surgeons. Enhanced Recovery After Surgery protocols for other specialties such as orthopedics and colorectal surgery have incorporated regional anesthetic blocks. These regional blocks have been shown to be effective in improving the patient comfort and experience and decreasing reliance on opioid medications...
January 28, 2019: Annals of Plastic Surgery
Zachary T Young, Michaela Close, Fernando A Herrera
BACKGROUND: The purpose of this study was to identify preoperative risk factors in patients undergoing reduction mammoplasty as well as identify any increased complication risk in patients older than 60 years undergoing reduction mammoplasty. METHODS: The American College of Surgeons National Surgical Quality Improvement Program data from years 2013-2015 was reviewed. Patients were identified using Current Procedural Terminology code 19318 specific for reduction mammoplasty...
January 28, 2019: Annals of Plastic Surgery
Joshua J Rivet, Kristopher M Day, Jeffrey F Rau, Jimmy L Waldrop, Mark A Brzezienski
PURPOSE: Acellular dermal matrices (ADMs) are commonly used for immediate breast reconstruction after skin-sparing mastectomy (SSM). Regnault grades 2 and 3 ptotic breasts feature significant mastectomy flap redundancy that may be incorporated into the reconstruction. This allows surgeons to use patients' de-epithelialized inferior dermal pedicle instead of ADM. METHODS: All consecutive SSM patients with Regnault grade 2 or 3 ptosis who underwent Passot-type immediate breast reconstruction (IBBR) with tissue expanders (TEs) and de-epithelialized inferior dermal pedicle without an ADM were included...
January 28, 2019: Annals of Plastic Surgery
Jenna Thuman, Alessandrina M Freitas, Christie Schaeffer, Chris A Campbell
INTRODUCTION: The obese or ptotic breast demonstrates significant difficulty in breast reconstruction after mastectomy with increased rates of perioperative complications compared with the general population, regardless of reconstruction type. Implant-based reconstruction in this patient population with the traditional horizontal elliptical skin-sparing mastectomy tends to have aesthetically displeasing qualities secondary to skin flap redundancy and blunting of the breast contour. Wise-pattern closures have been described with submuscular direct-to-implant and 2-stage reconstructions, with more favorable complication profile when staged...
January 28, 2019: Annals of Plastic Surgery
Jiunn-Tat Lee, Li-Fu Cheng, Honda Hsu, Meng-Si Wu, Sou-Hsin Chien
BACKGROUND: In patients with diabetic foot ulcers requiring flap reconstruction, the choice of local flaps is limited by the lack of adequate tissue available. Free flaps are often bulky, presenting footwear difficulty due to poor contouring. Here, we present our experience of using the proximal lateral leg perforator flap in the reconstruction of thin diabetic foot ulcers. METHODS: This is a retrospective study of 17 patients with diabetic foot ulcers reconstructed with the proximal lateral leg perforator flap during January 2013 and December 2015...
January 28, 2019: Annals of Plastic Surgery
Raffaele Ceccarino, Rosa Di Micco, Renato Cappelletti
Throughout the last decade, aesthetic breast surgery has enormously spread in the outpatient clinic setting where plastic surgeons perform the vast majority of procedures under local anesthesia as day-case operations. The "tumescent anesthesia" is defined as the injection of a dilute solution of local anesthetic combined with epinephrine and sodium bicarbonate into subcutaneous tissue until it becomes firm and tense, which is "tumescent." The "cold tumescent anesthesia" (CTA) derives from Klein's solution with the introduction of a new concept, which is the low temperature (4°C) of the injected solution...
January 21, 2019: Annals of Plastic Surgery
Ivica Ducic, Joshua Yoon
PURPOSE: The investigators wanted to evaluate, analyze, and compare the current microsurgical repair modalities (primary repair, autograft, tube conduit, and allograft reconstruction) in achieving functional sensory recovery in inferior alveolar and lingual nerve reconstructions due to injury. METHODS: A literature review was undertaken to identify studies focusing on microsurgical repair of inferior alveolar and lingual nerve injuries. Included studies provided a defined sample size, the reconstruction modality, and functional sensory recovery rates...
January 14, 2019: Annals of Plastic Surgery
Jonathan S Lam, Benjamin K Simpson, Frank H Lau
BACKGROUND: Today, plastic surgeons have largely transitioned to digital photography. This shift has introduced new risks to daily workflows, notably data theft and Health Insurance Portability and Accountability Act (HIPAA) violations. METHODS: We performed a national survey of digital photograph management patterns among members of the American Society of Plastic Surgery and trainees in Accreditation Council for Graduate Medical Education-accredited plastic surgery programs...
January 14, 2019: Annals of Plastic Surgery
Andreas T Nissen, Dominic Henn, Shawn Moshrefi, Deepak Gupta, Rahim Nazerali, Gordon K Lee
BACKGROUND: Quality of life (QOL) is an important outcome measure after ventral hernia repair (VHR). The Hernia-Related QOL Survey (HerQLes) is a specific survey tool for QOL after VHR. Studies comparing QOL in patients with biologic mesh repairs (BMRs) and synthetic mesh repairs (SMRs) are lacking. STUDY DESIGN: A survey based on the HerQLes was administered via e-mail to 974 patients who had undergone VHR at Stanford Medical Center. From 175 patients who were included in the study, the mean HerQLes scores and postoperative complications were compared between patients with suture repairs (SR), BMR, SMR, with and without component separation, and different types of SMR...
January 9, 2019: Annals of Plastic Surgery
Nadine S Hillberg, Tom J M van Mulken, Marleen A J Meesters-Caberg, Andrzej Piatkowski, Xavier A H Keuter, Juliette Hommes, René R W van der Hulst
The deep inferior epigastric artery perforator (DIEP) flap is one of the most used free flaps for the reconstruction of the breast after a mastectomy. Despite careful selection of the patients and preoperative imaging, difficulties in vascularization of the flap can occur in some cases. Although multiple vascular connections (bipedicled, turbocharged, or stacked) can be made in selected cases, there can still be venous congestion before the flap is transferred.Between 2016 and 2018, 4 cases in our series of 281 patients experienced such problems...
January 9, 2019: Annals of Plastic Surgery
Spencer R Anderson, Michelle R Sieffert, Colonel Matthew R Talarczyk, R Michael Johnson, Major Justin P Fox
PURPOSE: Despite changes in legislation and an increase in public awareness, many women may not have access to the various types of breast reconstruction. The purpose of this study was to evaluate variation in reconstructive modality at the health service area (HSA) level and its relationship to the plastic surgeon workforce in the same area. METHODS: Using the Arkansas, California, Florida, Nebraska, and New York state inpatient databases, we conducted a cross-sectional study of adult women undergoing mastectomy for cancer from 2009 to 2012...
January 9, 2019: Annals of Plastic Surgery
Steven A Ovadia, Seth A Spector, Seth R Thaller
INTRODUCTION: With increasing health care expenses and limited resources, it is important to evaluate potential means of reducing cost while maintaining efficacy and safety. The purpose of our study was to compare the cost and outcomes of surgical excision of nonmelanoma skin cancer (NMSC) in the operating room versus an outpatient procedure clinic. METHODS: A retrospective review of patients undergoing excision of biopsy-confirmed NMSC at the Miami Veterans Affairs Hospital between December 1, 2015, and December 1, 2016, was completed...
January 9, 2019: Annals of Plastic Surgery
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